4 - Male Urology Flashcards
What is phimosis?
- Foreskin cannot be fully retracted from around the tip of the penis
- Normal to be non-retractable in adolescence, e.g 50% cannot be retracted at 1 year
What can be the consequences of phimosis?
- Poor hygeine so more STDs
- Pain
What is Balantis Xerotica Obliterans?
- Lichen sclerosus of the male genitalia
- A chronic, often progressive disease, which can lead to phimosis and urethral stenosis
What is paraphimosis and what are the most commonest causes?
- Foreskin can no longer be pulled forward over the tip of the penis causing the foreskin to become swollen and stuck
- Phimosis, Catheterisation (esp the elderly) and Penile Cancer are all causes
How do you treat phimosis and paraphimosis?
- Circumsion for phimosis (be careful if have phimosis and balantis, may have underlying cancer)
- Needs reduction manually or dorsal slit may be necessary
What type of cancer is penile cancer and what are the risk factors?
- Squamous cell carcinoma
- Really rare
- Phimosis, hygeine and smegma are risk factors
- HPV 16 and 18 are risk factors
- Untreated most die in two years
Why may a male have a circumsion?
What are some of the causes of acute scrotal pain?
- Testicular torsion
- Epididymitis/Orchitis/Epididymoorchitis
- Torsion of hyatid of Morgagni
- Trauma
- Ureteric calculi (referred pain, often blood in urine)
What can epididymitis be caused by?
- UTIs
- STIs
- Mumps
How would testicular torsion present?
- Younger patient
- Sudden onset e.g wake to pain
- Unilateral pain
- May be vomiting and no LUTS
- Tender testes that lie high and horizontal in scrotum
EMERGENCY SCROTAL EXPLORATION - don’t waste time with tests
What would you see in the history and examination of a male with epididymo-orchitis?
- Gradual unilateral onset
- Recent history of UTI, unprotected sex, mumps, catheter
- Age 20-40 STI (Chlaymdia) and 40/50 often UTI (E.Coli)
- Pyrexial
- Red enlarged tender testis or epididymis
- May have reactive hydrocoele or fluctuant areas showing an abscess
- Fournier’s Gangrene (high mortalitiy)
What is Fournier’s gangrene?
Type of necrotizing fasciitis affecting the external genitalia as a complication of epididymitis, more common in poorly controlled diabetes
How do you investigate suspected epididymoorchitis and treat it?
- Blood cultures and FBCs
- Mid stream urine sample
- Scrotal ultrasound if suspected abscess
What are some questions you need to ask when a male presents with a scrotal lump?
- Is it painful?
- How quickly has it occured?
- Can I get above it? If yes it is scrotal in origin
- Is it in the body of the testes? If yes it could be a tumour
- Is it separate to the testis?
- Does it fluctuate and transilluminate?
What are some common causes of scrotal lumps?
Painless:
- Testis tumour
- Epididymal cyst
- Hydrocoele
- Reducible inguino-scrotal hernia
- Varicocoele (aching at end of day)
Painful:
- Epididymitis
- Epididymo-orchitis
- Stranfulated inguino-scrotal hernia
What is the history of a testicular tumour and what should be the treatment plan if you suspect this?
- Usually a painless lump you can get abovw
- Usually a germ cell tumour if aged<45 and risk factor of a history of maldescended testis. In older men can be lymphoma
- Urgent 2 week referral to urology for testis tumour markers (aFP, hCG, LDH) and arrange urgent ultrasound
What would a hydrocele appear like on history and examination?
- Slow or suddent onset and can be bi/unilateral
- Imbalance in the fluid production and resorption between tunica albuginea and tunica vaginalis
- Testis may not be palpable separately
- Transilluminates
- Can get above
How does an epididymal cyst present on examination?
- Usually painless
- Separate from the testis
- Can get above the mass
- Transilluminates
How does a varicocele present?
- Dull ache at the end of the day
- Bag of worms above testis
- Not tender
- More common in left than right
- Can be associated with reduced fertility or renal pathology so check for palpable abdominal mass
How do we treat the following scrotal lumps?
- Testicular tumour
- Epididymal Cyst
- Hydrocele
- Varicocele
- Inguino-scrotal hernia
What are some of the causes of urinary retention? (more common in males than females)
- Prostatic enlargement e.g BPH or prostate cancer
- Phimosis/Urethral Stricture/Meatal stenosis
- Constipation
- UTI
- Anticholinergic drugs (e.g schizophrenia drugs and drugs for overactive bladder)
- Over distension e.g drunk too much at party
- Following abdominal surgery (from nerve damage or the anaesthesia)
- Neurological
What are the three different types of urinary retention and how do we treat them?
Acute: TWOC after fixing the main cause e.g constipation
Chronic: intermittent self catheterisation
Acute-On-Chronic: long term catheter or surgical intervention
When an older man presents with eneuresis what is your initial diagnosis?
Chronic retention with overflow incontinence until proven otherwise
What are the two different categories of LUTS and what can be some of the causes of each category?
Storage: irritative (stones), overactive bladder (idiopathic or neuropathic e.g MS), low compliance of bladder from scarring (TB and schistomiasis), polyuria
Voiding: bladder outflow obstruction (e.g phimosis, BPH), lack of coordination between bladder and urinary sphincter due to upper motor neurone lesion, reduced contractility due to lower motor neurone lesion
